Health Committee on June 15th, 2006

[The Chair, Conservative, Rob Merrifield]

I think you have the picture. You have a minute and a half.

[Dr. Diane T. Finegood]

I would say the two biggest things are to have both a top-down and a bottom-up approach. On the top-down approach, the kinds of actions we could take that would have a huge impact would be related to regulating advertising to children on television. I think there are good estimates to show that could have a huge impact on behaviour.

And the bottom-up approach needs to be where we seed communities to undertake their own actions that are going to work within those communities, and we provide them the tools to measure the effectiveness of those activities so that they know and can do it better as they move along in the future.

[Dave Batters, Conservative, Palliser, SK]

Does anybody else wish to comment?

[Sally Brown]

We agree with those.

Probably at the top of our list we would have put school policies as an immediate hit, and that includes food available at the schools, physical activity in the schools and after the schools, and education and incentives around a healthier lifestyle. So we would say school policies would be the best place to start.

[Dave Batters, Conservative, Palliser, SK]

Do I have more time, Mr. Chair?

[The Chair, Conservative, Rob Merrifield]

Not for another question, but if there are more responses we'll hear them.

[Francy Pillo-Blocka]

I agree with what's been said already, but keep in mind two things. The equation has to do with food and it has to do with activity, and not just with one of these. Whatever we're doing has to keep those things in mind, because they're parts of the energy balance.

[The Chair, Conservative, Rob Merrifield]

Peter.

[Dr. Peter T. Katzmarzyk]

I'd like to add to those comments and say, regarding a healthy school environment, that it's just criminal that we're sitting around debating the merits of physical activity or healthy diets in the schools and there are people up in arms about the government getting in their faces. The amount of physical activity that's going on in the schools is just criminal.

[A voice]

Or that's not going on.

[The Chair, Conservative, Rob Merrifield]

Thank you very much.

Stephen.

[Stephen Samis]

One thing the federal government can do—it's the sole jurisdiction of the federal government—is to improve our data infrastructure and invest the money we need for a lifelong cohort study, so that we can understand health outcomes and factors that influence us over a lifetime for different kinds of communities.

[The Chair, Conservative, Rob Merrifield]

Ms. Davidson, you have five minutes.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thanks, Mr. Chairman, and my thanks to all of the presenters today. It has certainly been extremely interesting, and we've received a tremendous amount of good data, I think.

I have a couple of comments to make, and I go back to Dr. Finegood's presentation. In slide 4 we see that the funding has increased four to five times over the years, but obesity is still increasing by leaps and bounds. So even though we are funding at an increased rate, we don't see results from it.

Then on slide 15 you say we need to be measuring effectiveness in the field. I look at those two things. Then, when Peter was speaking he said, if I heard him correctly, he'd been working for 15 years on this issue of obesity. I think we're all starting to recognize that childhood obesity is a worldwide epidemic, and you said, I believe, that Canada was the fifth-worst in the world for the numbers, and that even though adult numbers are rising for obesity, we're seeing huge leaps and bounds in childhood obesity, that it's increasing far more rapidly in children.

You've pointed out the anomalies from eastern Canada and said we need to do a study on those, and you spoke of the $1.6 billion in costs directly to the health care system and the $2.3 billion indirectly—huge, phenomenal amounts of dollars that are going towards this for health costs.

I guess my question, to whoever wants to address it, is, do we not have any measurements in place? You're saying on one hand that things need to be measured, but we're hearing from everybody that although funding has increased, the results are not there to reflect the increase in funding. So are we using any measurements, are they incorrect measurements, or do we just not have measurements at this point?

[Dr. Diane T. Finegood]

It's a big question. Let me make a few comments in response. One is that the funding you saw on page 4 is for all obesity research, everything from trying to understand the genes that play a role in determining obesity to working with communities in ways that will help communities to find approaches that work for them and to understand whether the approaches work. So it's the sum total, and it's far too little, given the size of the problem.

There's a long delay between when one starts research and when you get the results and then when their impact actually happens. One of the biggest issues, really, is to close the gap between knowledge development and knowledge transfer. That's something I go back to; that when you work with communities that are trying to develop programs, you are really communicating and transferring knowledge. In those bar graphs, there are even grants that Dr. Katzmarzyk has gotten from us to help us understand the magnitude of the problem. His work isn't necessarily going to solve the problem; it's going to bring it to your attention first, and then we have to work with communities and community groups and in partnership with our other health portfolio partners to ensure that when we seed communities with health promotion funding they actually are understanding the impact of their activities.

Does that address your question adequately?

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Yes, thank you.

[Sally Brown]

As Dr. Finegood said, there are various types of research. One area in which we don't do a lot of it and should be doing more is what I'll call intervention research, so that when we make a change in a community, we research it. A lot of the research is telling us why we should be doing things, what the basis of the actions is. We're not doing enough research in Canada on what works. When you implement a change in a community, the requirement should be almost, if it's government-funded, that money be set aside to research the success of that intervention, so that if it succeeds it can be applied and if it doesn't we won't waste our money applying that intervention in other communities when there's no evidence it works. We can do more of that kind of research in Canada.

[The Chair, Conservative, Rob Merrifield]

Stephen.

[Stephen Samis]

I would also add that much of the research that has been funded is still relatively recent research, which Diane pointed out, and the huge spike in research is still relatively new. Some of the research is ongoing.

I think many of the things that we've talked about here today in terms of the environmental issues around obesity and the school situation, with soft drinks in schools, etc., have been brought to our attention through some of the research that's been funded. It is starting to have an impact on policy. As Sally said, we now have to really measure the interventions of those policies that take place.

A lot of the research that has come forward has started to describe the problem. Policy makers are starting to act. Our data infrastructure in the country is such that we are only really able to do descriptive research. It's very difficult for us to get at a lot of the processes under way, given the limited data sources we have.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Thank you.

[The Chair, Conservative, Rob Merrifield]

Mr. Dykstra.

[Rick Dykstra, Conservative, St. Catharines, ON]

Thank you, Mr. Chair.

I have a couple of things.

It's actually been fascinating to listen. Thank you very much for your presentations. It certainly helps.

From one of the things you mentioned, Peter, I get the impression that we're making progress from an adult perspective with respect to the issue, but not with our children. I don't know how you can explain it, but it seems to me to be a dichotomy.

I know that if we're eating healthy food in our household, our children are eating healthy food. I'm trying to understand why there isn't a positive relationship among adults eating healthier and children not doing so. Maybe it has to do with physical activity, but I'd appreciate a clarification.

[Dr. Peter T. Katzmarzyk]

No, there is certainly a strong relationship. There's a strong family resemblance in diet and physical activity, not only genetically but in the shared household environment. We really have to start at home for that type of thing. There's definitely a high degree of correlation, but we don't know about the health care costs for kids.

[Rick Dykstra, Conservative, St. Catharines, ON]

Right, the impact of it.

Stephen, you mentioned the fact that you've been coming to the committee for about four years and asking for an implementation of the strategy. I thought it was a pretty fair and bold statement. Could you follow up on why you think that's the case?

[Stephen Samis]

Why I think that's the case?